<div class="form">

<?php $form=$this->beginWidget('CActiveForm', array(
	'id'=>'patients-form',
	'enableAjaxValidation'=>false,
)); ?>

	<p class="note">Fields with <span class="required">*</span> are required.</p>

	<?php echo $form->errorSummary($model); ?>

	<div class="row">
		<?php echo $form->labelEx($model,'outpatient'); ?>
		<?php echo $form->textField($model,'outpatient'); ?>
		<?php echo $form->error($model,'outpatient'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'hospitalId'); ?>
		<?php echo $form->textField($model,'hospitalId'); ?>
		<?php echo $form->error($model,'hospitalId'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'gender'); ?>
		<?php echo $form->textField($model,'gender'); ?>
		<?php echo $form->error($model,'gender'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'dateOfBirth'); ?>
		<?php echo $form->textField($model,'dateOfBirth'); ?>
		<?php echo $form->error($model,'dateOfBirth'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'frstName'); ?>
		<?php echo $form->textField($model,'frstName',array('size'=>60,'maxlength'=>75)); ?>
		<?php echo $form->error($model,'frstName'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'middleInitial'); ?>
		<?php echo $form->textField($model,'middleInitial',array('size'=>10,'maxlength'=>10)); ?>
		<?php echo $form->error($model,'middleInitial'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'lastName'); ?>
		<?php echo $form->textField($model,'lastName',array('size'=>60,'maxlength'=>100)); ?>
		<?php echo $form->error($model,'lastName'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'height'); ?>
		<?php echo $form->textField($model,'height'); ?>
		<?php echo $form->error($model,'height'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'weight'); ?>
		<?php echo $form->textField($model,'weight'); ?>
		<?php echo $form->error($model,'weight'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'emergencyContactName'); ?>
		<?php echo $form->textField($model,'emergencyContactName',array('size'=>60,'maxlength'=>125)); ?>
		<?php echo $form->error($model,'emergencyContactName'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'emergencyContactNumber'); ?>
		<?php echo $form->textField($model,'emergencyContactNumber',array('size'=>15,'maxlength'=>15)); ?>
		<?php echo $form->error($model,'emergencyContactNumber'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'homePhone'); ?>
		<?php echo $form->textField($model,'homePhone',array('size'=>15,'maxlength'=>15)); ?>
		<?php echo $form->error($model,'homePhone'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'cellPhone'); ?>
		<?php echo $form->textField($model,'cellPhone',array('size'=>15,'maxlength'=>15)); ?>
		<?php echo $form->error($model,'cellPhone'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'comments'); ?>
		<?php echo $form->textField($model,'comments',array('size'=>60,'maxlength'=>255)); ?>
		<?php echo $form->error($model,'comments'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'insuranceName'); ?>
		<?php echo $form->textField($model,'insuranceName',array('size'=>60,'maxlength'=>100)); ?>
		<?php echo $form->error($model,'insuranceName'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'insuranceCardNumber'); ?>
		<?php echo $form->textField($model,'insuranceCardNumber',array('size'=>25,'maxlength'=>25)); ?>
		<?php echo $form->error($model,'insuranceCardNumber'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'emailAddress'); ?>
		<?php echo $form->textField($model,'emailAddress',array('size'=>60,'maxlength'=>75)); ?>
		<?php echo $form->error($model,'emailAddress'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'createdBy'); ?>
		<?php echo $form->textField($model,'createdBy',array('size'=>10,'maxlength'=>10)); ?>
		<?php echo $form->error($model,'createdBy'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'createdTime'); ?>
		<?php echo $form->textField($model,'createdTime'); ?>
		<?php echo $form->error($model,'createdTime'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'updatedBy'); ?>
		<?php echo $form->textField($model,'updatedBy',array('size'=>10,'maxlength'=>10)); ?>
		<?php echo $form->error($model,'updatedBy'); ?>
	</div>

	<div class="row">
		<?php echo $form->labelEx($model,'updatedTime'); ?>
		<?php echo $form->textField($model,'updatedTime'); ?>
		<?php echo $form->error($model,'updatedTime'); ?>
	</div>

	<div class="row buttons">
		<?php echo CHtml::submitButton($model->isNewRecord ? 'Create' : 'Save'); ?>
	</div>

<?php $this->endWidget(); ?>

</div><!-- form -->